1 Tex. Admin. Code § 370.4 – Definitions

The following words and terms, when used in this chapter, shall have the following meanings, unless the context clearly indicates otherwise:

(1) Action--
1. (A) Denial of CHIP eligibility;
2. (B) Disenrollment from CHIP:
3. (C) The failure of the Health and Human Services Commission (HHSC) or its designee to act within 45 days on an Applicant's request for CHIP eligibility determination.
4. (D) "Action" does not include expiration of a time-limited service.
(2) Alien--A person who is not a native born or naturalized citizen of the United States of America.
(3) Applicant--An individual who lives with the child and applies for health care coverage on behalf of the child. An applicant can only be:
1. (A) a child's parent, whether biological or adoptive;
2. (B) a child's grandparent, relative or other adult who provides care for the child;
3. (C) a minor not living with an adult relative applying for himself/herself; or
4. (D) a child's step-parent.
(4) Application--The standardized, written document that an applicant must complete to apply for health care coverage through CHIP.
(5) Budget Group--The group of individuals who live in the home with the child for whom an application for health care coverage is submitted and whose information is used to establish family size and calculate income. Individuals receiving Supplemental Security Income payments are not included in the Budget Group. Budget Group members include only:
1. (A) the child seeking health coverage;
2. (B) the child's siblings under age 19 who live with the child (biological, adopted, or step-siblings);
3. (C) the child's biological or adoptive parents;
4. (D) the child's step-parent;
5. (E) the child's spouse, if married, and they have children.
(6) Child--An individual under the age of 19.
(7) Children's Health Insurance Program or CHIP or Program--The Texas State Children's Health Insurance Program established under Title XXI of the federal Social Security Act (42 U.S.C. §§1397aa, et seq.) and chapters 62 and 63, Health and Safety Code.
(8) Children's Health Insurance Program Service Area or CSA--One of the designated areas in the state that is served by one or more of the CHIP Health Plans or the CHIP Exclusive Provider Organization.
(9) Commission or HHSC--The Texas Health and Human Services Commission.
(10) Cost Sharing--Any enrollment fees or co-payments the enrollee is responsible for paying.
(11) Countable Income--For the month of receipt any type of payment that is a regular and predictable gain or a benefit to a Budget Group that is not specifically exempted. Regular and predictable income is income received in one month that is either likely to be received in the next month and was received on a regular and predictable basis in past months. It does not include income that was received on an irregular and unpredictable basis in past months, or is received by the child or sibling member of the Budget Group who is under age 18 and enrolled in school fulltime, or in school part-time and working less than 30 hours per week.
(12) Countable Liquid Assets--Personal Property that is cash or that an Applicant can readily convert to cash that is used in calculating a child's eligibility for CHIP.
1. (A) Countable liquid assets include the balances, less income received or deposited in the current month of the following:
  1. (i) cash on hand;
  2. (ii) cash in the bank;
  3. (iii) cash in a Temporary Assistance to Needy Families (TANF) Electronic Benefit Transfer account;
  4. (iv) money remaining from the sale of a homestead; and
  5. (v) accessible trust funds.
2. (B) Countable Liquid Assets do not include:
  1. (i) any resource exempted by federal law from consideration for purposes of determining eligibility or benefit levels for any federally funded needs-based program, such as TANF and Assets for Independence Act (AFIA) Individual Development Accounts; or
  2. (ii) any financial instrument subject to rules limiting use of its proceeds, including penalties and/or tax liabilities incurred for early liquidation, such as individual retirement accounts and Keogh plans; or
  3. (iii) the cash value of any insurance policy; or
  4. (iv) Internal Revenue Code 529 qualified college savings program accounts, such as Texas Guaranteed Tuition Plan accounts; or
  5. (v) funds received as educational grants or scholarships.
(13) Day--Calendar day, unless otherwise specified.
(14) Designee--A contractor of HHSC authorized to act on behalf of HHSC under this chapter.
(15) Enrollment--The process by which a child determined to be eligible for CHIP is enrolled in a CHIP health plan serving the CHIP Service Area in which the child resides.
(16) Exempt Income--Income received by the Budget Group that is not counted in determining income eligibility.
(17) FPL--Federal Poverty Level Income Guidelines.
(18) Gross Budget Group Income--Monthly Countable Income before any payroll deductions.
(19) Health Plan--A licensed health maintenance organization, indemnity carrier, or authorized exclusive provider organization that contracts with the Commission to provide health benefits coverage to CHIP members.
(20) Household--The Budget Group plus any SSI recipient who is the child's:
1. (A) sibling who lives with the child (biological, adopted, or step-sibling);
2. (B) biological or adoptive parent; or
3. (C) step-parent.
(21) Member--A child enrolled in a CHIP Health Plan.
(22) Qualified Alien--An alien who, at the time of application, satisfies the criteria established under 8 U.S.C. §1641(b).
(23) SSI--Supplemental Security Income.
(24) State Fiscal Year--The 12-month period beginning September 1 of each calendar year and ending August 31 of the following calendar year.

Source Note:The provisions of this §370.4 adopted to be effective April 4, 2001, 26 TexReg 2519; amended to be effective September 1, 2003, 28 TexReg 7337; amended to be effective August 24, 2004, 29 TexReg 4448; amended to be effective January 1, 2006, 30 TexReg 8666.